2017年 · 第53卷第03期

This issue focuses on the research progress of ocular surface diseases. The responsible editorial committee responsible for the planning, composition and review of the key contents of this issue is Professor Shi Weiyun.

At present, trabeculectomy is still one of the most predominant anti-glaucoma surgical methods. However, this operation has many complications such as bleb ptosis, thin wall bleb, bleb inflammation, endophthalmitis, etc., and causes permanent ocular surface changes. Therefore, finding non-bleb-dependent anti-glaucoma surgery has been a hot spot of clinical attention. Mucosal tubuloplasty can achieve the goal of reducing intraocular pressure by dredging the physiological channels of aqueous humor. Because the operation completely eliminates the complications associated with filtering vesicles and has a good effect of lowering intraocular pressure, this operation has become one of the important surgical methods for open-angle glaucoma^[1]。 However, the operation is complicated, requires the fabrication of scleral cistern and Dickel membrane window, and the incidence of intraoperative complications is high. Clinical studies using UBM examination found that patients can still maintain good intraocular pressure after mucous tubuloplasty with the disappearance of the scleral cistern and the closure of the Dickel membrane window, indicating that the most difficult step in this operation, that is, the making of the scleral cistern and Dickel membrane window may not be necessary for the operation. Therefore, aqueous humor outflow pathway reconstruction, i.e., mucous tubuloplasty without the need to make scleral cistern and Dickel membrane window during the operation, not only has a similar surgical success rate as mucous tubuloplasty, but also avoids related surgical complications and has better safety^[2,3,4]。

Primary congenital glaucoma is the main type of glaucoma in children. It is a kind of glaucoma caused by abnormal development of eyeball angle tissue during embryonic and developmental stages. The first choice of treatment for primary congenital glaucoma is surgery. At present, the most commonly used surgical method is external trabeculotomy. However, this procedure has shortcomings such as unclear incision site and small incision range (120°).

Fundus yellow spot disease is a familial hereditary fundus lesion, which mostly involves both eyes. Its pathological changes first occur in RPE, and local atrophy of photoreceptor cells and choroidal capillaries appears as the disease progresses. The lesions are usually located at the posterior pole, and with damage to the structures of the macular area, visual acuity also decreases significantly. There have been clinical reports on binocular yellowspots complicated with choroidal neovascular membrane in the macular area in one eye^[1]However, fundus yellowspots combined with other macular diseases are relatively rare. A patient with binocular yellowspots complicated with macular defect was admitted to the outpatient department of Tianjin Eye Hospital, which is reported as follows.

A 38-year-old male was admitted to Tianjin Medical University Eye Hospital on August 22, 2013 due to obscuration of the nasal shadow of his left eye for 2 d. The patient had previously been highly myopic in both eyes with a diopter number of-13.00 D and congenital nystagmus in both eyes. The patient's parents were not close relatives, and there were no other patients suffering from albinism in the family. The patient's parents, younger siblings and only son did not have similar manifestations. At the time of admission, the examination found that the hair color was pale, and there was no abnormality. Eyebrows and eyelashes have a touch of white. Ocular examination: right eye visual acuity 0.1, correction 0.12, intraocular pressure 14.6 mmHg (1 mmHg =0.133 kPa), pendulum nystagmus, anterior segment (-), clear optic disc boundary visible in the fundus, leopard print retina, posterior pole RPE without pigment, and thick choroidal blood vessels visible. The visual acuity of the left eye was manual before the eye, correction was not improved, intraocular pressure was 9.4 mmHg, ocular pendulum tremor, anterior segment (-), wavy retinal bulge at 4~6 o'clock in the fundus, involving the macular area, a horseshoe-shaped hole at 1 o'clock, about 3/4 PD in size, the posterior pole RPE was depigmented, and thick choroidal blood vessels were seen (Figure 1）。 Auxiliary examination: B-ultrasound showed left eye retinal detachment, OCT showed left eye temporal macular neuroepithelial detachment. Diagnosis: Rhegmatogenous retinal detachment in left eye, fundus alterations in albinism in both eyes, congenital nystagmus in both eyes, high myopia in both eyes, and high myopic retinopathy in both eyes. Treatment plan: Left eye vitrectomy + gas-liquid exchange + retinal photocoagulation + silicone oil filling was performed under local anesthesia on 23 August 2013. Postoperative eye examination: Left eye visual acuity 0.1, +5.00 D corrected to 1.2, intraocular pressure 12.9 mmHg, vitreous cavity filled with silicone oil, posterior pole RPE without pigment in the fundus, thick choroidal blood vessels, hiatus closed, omentum in place (Figure 2）。 Silicone oil removal of left eye under local anesthesia was performed on 10 Mar 2014. Postoperative ocular conditions: Left eye visual acuity 0.02, intraocular pressure 13.7 mmHg, retina in position. After that, the patient's visual acuity gradually decreased, and the examination found that the lens was opaque and the retina was in place. Left eye cataract phacoemulsification with intraocular lens implantation under local anesthesia on 20 Mar 2015.

The patient was a 46-year-old female with visual acuity decline in her left eye for 1 month. She came to the Ophthalmology Center of Wuhan University People's Hospital on August 26, 2015. Patient's past history: 5 years of premature cardiac beats, no special treatment. History of eye disease and trauma were denied. Ophthalmologic examination: 1.0 for right eye and 0.06 for left eye. IOP is normal. The slit lamp examination of the anterior segment of both eyes showed no abnormalities. The fundus image shows that the optic disc of both eyes is clear and correct in color, the retina is flat, the blood vessels are distorted and dilated, and small patches of bleeding can be seen below the nasal side of the optic disc of the right eye, and the reflection of the fovea is vague; There were several small patches of bleeding scattered on the temporal side of the optic disc of the left eye, and the foveal reflection was dim (Figure 1,Figure 2）。 Wide-angle FFA showed hemorrhagic occlusion fluorescence below the nasal side of the right eye optic disc; There were several scattered bleeding on the temporal side of the optic disc of the left eye to block the fluorescence. The second and third grade arterioles of the retina in both eyes were distorted, especially in the posterior pole and around the optic disc, and the ends showed spiral-like changes without dilatation, coarctation and fluorescein leakage. No abnormalities were observed in the retinal aorta and veins (Figure 3）。 Fundus examination was performed immediately on two family members of the patient's son and daughter, and it was found that the color fundus photograph of her daughter (24 years old) showed symmetrical macular arterioles in both eyes (Figure 4,Figure 5), autofluorescence and flow imaging OCT showed binocular symmetrical second and third grade macular arterioles tortuous (Figure 6,Figure 7）。 Diagnosis: Familial retinal arteriole deformity in both eyes. No special treatment was given, and regular follow-up was instructed.

Common causes of inferior rectus dysplasia leading to superior strabismus include inferior rectus absence, inferior rectus hypoplasia and inferior rectus attachment point ectopia. Among them, the most common one reported in the literature is the absence of inferior rectus muscle^[1]In this case, the attachment point of the inferior rectus muscle is ectopic.

Example 1The patient was a 37-year-old male. Due to conjunctival mass in his right eye since childhood, he was consulted on November 26, 2007. The patient was in prior health and had no family genetic history. Eye examination: visual acuity 1.0 in the right eye and 1.2 in the left eye. Intraocular pressure: 10.0 mmHg (1 mmHg =0.133 kPa) in the right eye and 10.1 mmHg in the left eye. No abnormalities were found in all examinations in the left eye. There was no congestion and edema in the eyelid of the right eye, no valgus and trichiasis. The lacrimal duct was irrigated unobstructed and no discharge was observed. The conjunctiva was mildly congested, the temporal bulbar conjunctiva was mildly flat and bulged, the surface was white and rough, with black hair visible, and the interior was yellowish-white, the distance between the outer edge and the limbus was 4 mm, and the inner edge was adhered to the conjunctiva at the lateral canthus, extending to the back of the bulb, and the inner edge insertion point was not visible (Figure 1), there was no yellowing stain and congestion of the sclera. The cornea is transparent, the anterior chamber axis is 1/2 CT deep, the iris texture is clear, the pupil is equal size and round, the diameter is 3 mm, the light reflection is present, and the lens density is normal. Fundus examination: optic disc boundary is clear, color is normal, C/D is 0.3, retina is flat, macula is dark. Orbital pressure was normal, and eyeball movement in all directions was normal. There was no double vision in both eyes. CT examination of orbital transverse axis (Figure 2): A uniform low-density shadow can be seen at the lateral bulb of the right orbit, with a CT value of-111.2 HU. It is adhered to the surface of the eye ring in a half-moon shape, with a chord length × chord height of 18 mm ×4 mm. The base occupies about 1/3 of the eye ring. The anterior edge is located behind the tangent point between the lens and the eye ring (equivalent to the corneoscleral limbus), and the posterior edge ends at the lateral rectus scleral attachment point. The highest point of the lesion bulge is located at the lateral front of the orbital margin, slightly pressing the lacrimal gland of the eyelid, and there is no obvious abnormal change in the bone quality of the orbital wall. A type of circular high-density shadow was visible in the lesion, close to the eye ring, with a size of about 6 mm ×5 mm, and a CT value of +803.2 HU. The blood and urine routine were normal, the electrocardiogram was normal, the chest radiograph was normal, and there were no other systemic diseases. Clinical diagnosis: dermoid lipoma of the conjunctiva of the right eye. Mass resection under local anesthesia was performed on 28 November 2007. Histopathological examination of tumor: Under the microscope, the tumor was adipose tissue, the epithelium was conjunctival and skin-like structure, and the underside was fiber, interspersed with a large number of adipocytes, and differentiated and mature bone tissue could be seen. Pathological diagnosis: Complex dermoid lipoma (complex fuzzoma) of the conjunctiva of the right eye. The patient recovered well after surgery. One week after surgery, the visual acuity was the same as before surgery, and there were no complications such as ptosis, reduction of tears, eye movement disorders and corneal diseases.

The patient was a 57-year-old male. Because he found that his right eye had turned black for 5 years, he went to the Department of Ophthalmology, Eye, Ear, Nose and Throat Hospital affiliated to Fudan University. One month ago, a new biopsy of the right conjunctiva was performed in an external hospital, and the histopathological examination diagnosed as malignant melanoma of the right conjunctiva. The whole body examination showed no abnormalities. Eye examination: visual acuity was 0.8 for the right eye and 1.0 for the left eye; IOP was 14 mmHg (1 mmHg =0.133 kPa) in the right eye and 13.5 mmHg in the left eye; the anterior segment of the right eye was presented inQuintessence Picture 1No obvious abnormalities were observed in the left eye. Clinical diagnosis: Malignant transformation of primary acquired melanosis of the corneoconjunctiva of the right eye. Subtotal extraction of orbital contents in the right eye was performed under general anesthesia. Postoperative pathological diagnosis: Primary acquired melanosis of the right corneal conjunctiva, with malignant transformation into melanoma in some areas.